Transcript Pott`s Disease - UNC School of Medicine

Musculoskeletal Tuberculosis
William Kwan
UNC Internal Medicine-Pediatrics
Pott’s Disease
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In endemic countries, usually affects children and young adults
In developed countries, often disease of older adults
20% of tuberculous infections are extrapulmonary
1-5% of tuberculous infections involve the musculoskeletal
system
 Involves thoracic spine in 50%
 Paraspinal abscesses develop in about half of all cases
 Pus can remain confined by ligaments and dissect along tissue
planes up to supraclavicular space and even down to posterior
iliac crest, groin, popliteal fossa
Pott’s Disease
 Should be suspected in patients with a history of
treated/untreated TB and new back pain
 May present with back pain solely without evidence of other
tuberculous foci or systemic signs
 If sinus formation, stains and cultures of pus positive for
mycobacterium only half of the time AND secondary infections
by other bacteria may also occur
 Variable ESR
Pott’s Disease
 X-rays may show irregular cavities and bony destruction without
surrounding sclerosis
 Usually involves anterior end plates, resulting in herniation of
intervertebral disks and “step-off” kyphosis
 MRI may show paravertebral abscesses without bony
involvement
 CT best for looking for bony destruction
 MRI best for looking for myelopathy or nerve compression
Extra-axial Tuberculosis
 Tuberculous arthritis and bursitis known to occur
 Usually involves a single site, but multiple site involvement
possible
 Progressive pain and swelling without systemic symptoms
 Phemister’s Triad:
 Juxta-articular osteoporosis
 Peripheral osseous erosions
 Joint space narrowing
 **Must biopsy and culture synovium and periarticular bone as
culture of synovial fluid is often nondiagnostic
Treatment
 6 to 9 months of INH and rifampin
 12 to 18 month regimens were suggested in the past
 1st 2 months should include ethambutol and pyrazinamide
 Surgery may be indicated if no response to therapy, instability of
spine, or neurologic deficits